Stroke Sufferers

I am pleased, Mr. Williams, to see you in the Chair. I want to reiterate the comments of other hon. Members in congratulating the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. I also want to congratulate him on the very comprehensive and detailed way in which he introduced this significant topic. He set out very clearly the importance of ensuring that the Government maintain the momentum that has been generated recently, first by the National Audit Office report, then by the Public Accounts Committee report and finally by the stroke strategy, which was released roughly a year ago. I thought that he made his points in a very constructive and thoughtful manner, and hopefully the Minister will respond in a similar vein. The hon. Gentleman was right to congratulate the Stroke Association, which does fantastic work in this area. I will not repeat them, but he was also right to highlight the four key markers that the Government set down. He was also correct to summarise the four distinct areas—the patient pathway—of awareness, diagnosis, treatment and subsequently community care and rehabilitation. If all those areas are addressed, that will make a significant difference to patient outcomes. The Minister will probably not have time to answer in detail all of the 14 questions that the hon. Gentleman put to him today, but I am sure that he will respond in writing to the hon. Members who are here with answers to all of those excellent questions. I also must say to my hon. Friend the Member for Isle of Wight (Mr. Turner) that his contribution today was exceptional and inspirational, and I am delighted to see that he has clearly made a full recovery and is back on full form, both in articulation and humour, which is very good to see. He was absolutely correct to highlight the important contribution of the charitable and voluntary organisations, particularly in rehabilitation and community support. He was also right to ask all of us, irrespective of our party political persuasions, to thank and congratulate the people involved in those organisations. As an additional question, it would be helpful if the Minister would address the point made both by my hon. Friend and by the hon. Member for North-West Leicestershire (David Taylor) about the potential to fund or assist charitable and voluntary organisations in the community and rehabilitation aspects of their work. We heard, too, from the hon. Member for Ceredigion (Mark Williams), who raised the important issue of the contributions of the voluntary and charitable sector. Furthermore, he stressed the overriding importance of people who have experienced strokes meeting others who have gone through a similar experience, if only to ensure that those people understand that they are not alone and that they are not unique in their experience of stroke. The hon. Gentleman was right to highlight the problems that are exacerbated in large rural constituencies. I, too, represent a rural constituency—the Lincolnshire constituency of Boston and Skegness—and I suspect that we have problems that are similar to those that he faces in north Wales. I sometimes think that the Government do not necessarily address the needs of those who represent physically great but sparsely populated rural areas and provide the requisite funding, although that is not the specific issue that we are debating today. The hon. Gentleman was also right to praise health professionals who are involved in stroke care. Of course, there is cross-party support for the enhancement of stroke services, particularly those that improve patient outcomes and survival rates, although it must also be said that, despite the stroke strategy, we still have fairly low survival rates in the UK in comparison with some other EU countries. Nevertheless, we recognise and welcome the progress that has been made since the publication of the stroke strategy, particularly in the development of stroke networks. However, it was a shame that it took the Government so long to produce that strategy, and I suspect that they did so only in response to the highly critical reports from the NAO and the Public Accounts Committee. Despite all the evidence that care in a specialist stroke unit increases a patient's chance of survival and recovery by 25 per cent. and reduces their stay in hospital by six days, in 2006 just 15 per cent. of stroke patients were admitted to stroke units on the day of admission. I accept and acknowledge that that is a slightly historic statistic. However, it would be helpful if the Minister could update it, either today or subsequently, particularly in the context of the overriding importance that is now correctly attributed to stroke and stroke care, both in the operating framework, which identifies stroke as a national priority, and in the primary care trusts' operational requirements, which was a point quite rightly made by the hon. Member for Nottingham, North. There are some background statistics that I briefly want to put on the record, because some of them are worrying. The national audit by the Royal College of Physicians this year showed that only 45 per cent. of hospitals were able to meet the target in the stroke strategy of investigating and treating high-risk patients with transient ischemic attack, or TIA, within 24 hours, and yet that is clearly one of the key methods of identifying patients at risk of stroke and preventing patients from going on to have a full stroke. Fast access to stroke units and fast treatment is a key to a patient's survival, whether that treatment is the CT scans that were mentioned earlier or the three-hour time limit for thrombolysis. These two methods of treatment must be linked, as the hon. Member for Nottingham, North pointed out, so that the thrombolysis is not administered to patients who would not benefit from it or to patients to whose health it would be detrimental. One statistic that has already been given is from Sweden, and it is absolutely startling compared with our own performance here in the UK; in Sweden, 100 per cent. of stroke patients have access to a CT scan within 24 hours. A quarter of British hospitals have no specialist stroke nurse and only 22 per cent. of hospitals have an early supported discharge team. Specialist teams working in a multidisciplinary framework are best placed to improve outcomes and reduce mortality. Last year, I visited the North Tyneside general hospital near Newcastle, which has a fantastic specialist stroke team. That team not only works in the hospital but goes into the community, with outreach workers and specialist nurses. I very much hope that that the Minister will ensure that that model is rolled out across the UK. One of the disparities that seems to exist between statements made by the hon. Member for Nottingham, North and the previous Government announcements relates to the population screening that the Prime Minister announced in January. It was clear from the Prime Minister's announcement that the screening would be whole-population screening with cardiovascular checks, which would also include looking for tell-tale signs of a stroke. It would be interesting if the Minister could say, first, whether or not the funding has been provided to support that whole-population screening and also whether or not the clinical evidence supports that type of screening, or is the hon. Member for Nottingham, North correct that screening should be limited to those between the ages of 40 and 74? We also support the ““hub and spoke”” strategy for specialist stroke centres. Clearly, there is a direct correlation between specialist stroke centres and better patient outcomes and survival rates; in those centres, patients are scanned and given thrombolysis if appropriate and necessary. However, that does not necessarily mean that there should be closures of small stroke wards in local hospitals. Indeed, Manchester is perhaps the best example of a good system; in the local service plan for Manchester, a hyper-acute unit has been proposed, where all stroke patients would be taken for the initial scan and treatment, before they are referred back to their district general hospitals for treatment to be continued and for subsequent treatment in the community. In the remaining few minutes, I have just a couple of additional questions for the Minister. Again, if he does not have time today—I clearly understand that this is the debate of the hon. Member for Nottingham, North—it would be helpful if he could write to me. For example, how much of the funding pledged for the stroke strategy has been delivered? How many of the stroke centres to date have achieved all 20 quality markers for a good stroke strategy? I assume that not all of them have achieved that target and, if so, what is the time scale for enabling all stroke centres to achieve it? Would the Minister also say a little about the awareness campaign that will begin next year? Has thought been given to the fact that it may stimulate additional demand, and does the NHS have the facilities and sufficient capacity to deal with such additional demand? Furthermore, what are the Government doing to support the communication needs of people who have suffered a stroke? That point was quite rightly made by other hon. Members. I also want to reiterate two key points made by other hon. Members; again, if the Minister does not have time to address them today, he and his team at least need to think about them. The first point is about awareness, including public awareness of stroke. A recent NOP poll demonstrated that there is both confusion and ignorance about the signs of stroke. Promoting awareness also includes the important factor of GPs. I was very concerned, as other hon. Members were, when I saw the statistic that about 20 per cent. of patients who go to GPs with a TIA are not referred on. The second key issue that hon. Members have raised, which the Minister will want to address, is the concern about ring-fenced money going to local authorities. That money has clearly been used, in some instances, for purposes for which it was not intended. That issue needs to be looked at, because it could have a detrimental impact on stroke care. In conclusion, we spend more on stroke services, as a nation, and there is rightly an increased focus on them, but we still have worse outcomes than comparable European nations. We should adopt more of the recommendations of the National Audit Office and the Select Committee on Public Accounts to enable our dedicated and hard-working stroke physicians, nurses and associated health care professionals to improve the quality of stroke care in the shortest possible time.